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Impact of topical nasal steroid therapy on symptoms of nasal polyposis

A Meta-Analysis

Authors

  • Luke Rudmik MD,

    1. Rhinology and Sinus Surgery, Division of Otolaryngology, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
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  • Rodney J. Schlosser MD,

    1. Division of Rhinology and Sinus Surgery, Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A.
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  • Timothy L. Smith MD, MPH,

    1. Division of Rhinology and Sinus Surgery, Oregon Sinus Center, Department of Otolaryngology–Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, U.S.A.
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  • Zachary M. Soler MD, MSc

    Corresponding author
    1. Division of Rhinology and Sinus Surgery, Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A.
    • Division of Rhinology and Sinus Surgery, Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue MSC 550, Charleston, SC 29425
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  • Dr. Schlosser has been a consultant for BrainLAB, Medtronic, Olympus, and Optinose, and has received grant support from FAMRI, Medtronic, Arthrocare, and NeilMed; Dr. Smith has been a consultant for Intersect and Entrigue and has received grant support from the NIH; Dr. Soler has been a consultant for ORA (Andover, MA). The authors have no other funding, financial relationships, or conflicts of interest to disclose.

Abstract

Objectives/Hypothesis:

Topical steroid therapy is an important strategy in the management of chronic rhinosinusitis (CRS) with nasal polyposis. The objective of this study was to determine the impact of topical steroid therapy on nasal symptoms in patients with nasal polyposis.

Study Design:

Systematic review with meta-analysis using standardized methodology.

Methods:

Study inclusion criteria included: randomized, placebo controlled trials, nasal polyposis, and topical steroid therapy. Exclusion criteria included: failure to report at least one symptom-based outcome measure, concurrent use of systemic steroids, or mixed CRS cohorts (polyp and nonpolyp patients). Quantitative analysis was performed using a random effect model. The PRISMA guidelines for meta-analysis reporting were followed.

Results:

A total of 19 studies fulfilled eligibility. Seven studies were excluded from the meta-analysis due to significant heterogeneity in outcome reporting. A total of 12 studies were combined for quantitative analysis and demonstrated a pooled risk ratio of 1.72 (95% confidence interval, 1.41–2.09), indicating a significant improvement in nasal symptoms. All three topical steroid preparations (fluticasone, mometasone, and budesonide) resulted in symptom improvement. All seven studies excluded from the meta-analysis qualitatively confirmed the overall findings.

Conclusions:

Topical nasal steroid therapy improves nasal symptoms in CRS patients with nasal polyposis. Future studies will need to evaluate the impact on quality of life, preferably using validated disease-specific instruments.

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